Holroyd Taylor A, Yan Shirley D, Srivastava Vineet, Srivastava Ashish, Wahl Brian, Morgan Christopher, Kumar Somesh, Yadav Amit K, Jennings Mary Carol
Johns Hopkins School of Public Health, Baltimore, MD, USA.
International Vaccine Access Center, Baltimore, MD, USA.
Health Promot Pract. 2022 Nov;23(6):1039-1049. doi: 10.1177/15248399211046611. Epub 2021 Oct 12.
India experiences a substantial burden of cervical cancer and accounts for nearly one third of cervical cancer deaths worldwide. While human papillomavirus (HPV) vaccines have been introduced subnationally in some states, HPV has not yet been rolled out nationally. Given the target age group, schools are the most common delivery channel for HPV vaccines, but this fails to account for local girls who never attended or no longer attend school. We conducted a qualitative, design-informed, community-based study conducted in Uttar Pradesh, India. We assessed facilitators and barriers among out-of-school girls and proposed program characteristics to inform the design of pro-equity HPV vaccine delivery programs for out-of-school girls. Programs should improve parental knowledge of the risk of cervical cancer, engage vaccinated girls as vaccine champions, utilize varied media options for low-literacy populations, and ensure that HPV vaccine services are accessible and flexible to accommodate out-of-school girls. In areas with poor or irregular school attendance among adolescent girls, HPV vaccine coverage will remain suboptimal until programs can effectively address their needs and reach this priority population. Our findings present a meaningful opportunity for program planners to purposefully design HPV vaccination programs according to these parameters, rather than modifying existing programs to include HPV vaccine. Adolescent girls, their parents, and other community members should be involved in program design to ensure that the program can effectively meet the needs of adolescent girls who are not in school.
印度宫颈癌负担沉重，占全球宫颈癌死亡人数的近三分之一。虽然人乳头瘤病毒（HPV）疫苗已在印度一些邦局部引入，但尚未在全国范围内推广。考虑到目标年龄组，学校是HPV疫苗最常见的接种渠道，但这没有考虑到从未上学或已不再上学的当地女孩。我们在印度北方邦开展了一项基于社区的定性研究，该研究参考了设计思路。我们评估了失学女童接种疫苗的促进因素和障碍，并提出了项目特点，以为针对失学女童的公平性HPV疫苗接种项目设计提供参考。项目应提高家长对宫颈癌风险的认识，让已接种疫苗的女孩成为疫苗宣传者，为低识字率人群采用多种媒体渠道，并确保HPV疫苗服务方便可得且灵活，以满足失学女童的需求。在少女上学情况不佳或不稳定的地区，在项目能够有效满足她们的需求并覆盖这一重点人群之前，HPV疫苗接种覆盖率仍将不理想。我们的研究结果为项目规划者提供了一个有意义的机会，使其能够根据这些参数有针对性地设计HPV疫苗接种项目，而不是修改现有项目以纳入HPV疫苗。少女及其父母和其他社区成员应参与项目设计，以确保项目能够有效满足失学少女的需求。
